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What is the treatment for stasis dermatitis?

Q: I am being treated as a follow-up case of stasis dermatitis and there is no satisfactory improvement. The symptoms are hyperpigmentation on the lower part of both legs (feet); swelling occurs on prolong standing. It all started 8 years back with red pigmentation marks on my feet. Later the red marks persisted and wounds came up after 2 years and then I went to Dermatologist who then prescribed medicine to successfully healed the wounds. With no remarkable improvements, I went for ayurvedic treatment for almost 6 months. No improvements still - then, I went to one more dermatologist who diagnosed it as some problem related to vein and it cannot be cured. Then, my parents decided to go to the hospital last year and till now I have visited the hospital 8 times. Tests done: 1. Skin Biopsy - Negative; 2. ANA/C-ANCA - Negative; 3. Blood & Urine Tests - Negative. I feel comfortable while walking but not standing, and I am unable to take excursion. Please help.

A:Stasis dermatitis is a common inflammatory skin disease that occurs on the lower extremities in patients with chronic venous insufficiency. The excess fluid in the tissues interferes with the bloods ability to feed the tissue cells and dispose of cellular waste products. The tissue becomes poorly nourished and fragile, resulting in stasis dermatitis. The disorder is common on the ankles because there is less supportive tissue in this area. You could try venous doppler studies may reveal deep venous thrombosis or severe valve damage due to past thrombosis as yet another test to confirm the diagnosis. The tests mentioned above are more than enough. Treatment options available are: Elevating the ankle while resting: Compression therapy (generally accomplished by means of specialised stockings that deliver a controlled gradient of pressure). More aggressive compression can be performed by using elastic wraps; compression (Unna) boots. You must know that compression therapy must be maintained on lifelong basis. Topical therapy: Using wet-to-damp gauze dressings soaked with water or with a drying agent, such as aluminum acetate. Topical corticosteroids are frequently used for reducing inflammation and itching in acute flares. You did not mention if you also have ulcers but if they are present then ulcers are best treated with compresses and bland dressings (eg, zinc oxide paste) & various other dressings (eg, DuoDerm) Oral antibiotics are useful when cellulitis (inflammation and redness) is present; topical antibiotics are useless and often cause contact dermatitis (eczema). When swelling subsides, split-thickness skin grafts (a kinds of plastic surgery) may be useful. Be wary of infection in stasis dermatitis; this becomes more problematic when using topical corticosteroids, which can make the patient more prone to infection. So my advice to you is to either consult a good vascular surgeon or a dermatologist so that suitable treatment can be formulated for you.

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